Editorials

Misleading meta-analysis

A meta-analysis of treatments in myocardial infarction published in 1992 retrospectively showed that streptokinase was associated with a highly significant fall in mortality by 1977, after inclusion of 15 trials.¹ Thrombolysis was, however, not widely recommended until 10 years later--after the effect was confirmed in two mega trials.^{1 2 3} In the case of magnesium, a substantial fall in mortality was evident by 1990, after inclusion of seven trials. In 1993, based on an updated meta-analysis it was argued that magnesium treatment represented an "effective, safe, simple and inexpensive" intervention that should be introduced into clinical practice without further delay.⁴ The negative results of ISIS 4 (the fourth international study of infarct survival), published in last week's Lancet,⁵ have dealt a blow to enthusiasm for both magnesium and meta-analysis.⁶ As the findings of meta-analyses and systematic reviews are generally not tested in mega . . . [Full text of this article]

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